The job values and expected tendencies that anesthesiologists thought importantly

BACKGROUND: This study was designed to figure out how anesthesiologists think about their job values and expected tendencies through questionnaires. METHODS: the directions for completing internet questionnaires were sent to all members and semi-members of the Korean Society of Anesthesiologists by email. Paper version of the same questionnaires was sent to residents of some university hospitals, who did not answer the internet questionnaires. the questionnaires consisted of items of basic, 14 job values and 80 expected tendencies. the answerers were asked to choose 4 items among job values and 10 items among 80 tendencies. the answers were analyzed according to the groups of job positions, subspecialties, ages and gender. RESULTS: Among items of job values, 'decision making', 'taking care of people', 'working with my hands' and 'working with my mind' were chosen by more than 40% of answerers, and answer rates were similar between each comparative groups. Among items of expected tendencies, 'be calm in crisis', 'make decisions rapidly', 'be perfectionistic', 'be good coordinators', 'be self-confident', 'think logically', 'be tolerant of others', 'be able to do more than one thing at a time', and 'be persevering' showed high answer rate, but the answer rate of individual items showed some differences between groups. CONCLUSIONS: Although there were some items that showed different answer rates between groups, there was little difference in job values and expected tendencies between groups on the wholeope

Chronic Back Pain Proven to Be Spinal Tuberculosis −A report of 2 cases−

The progression of spinal tuberculosis is usually slow and insidious, and its main symptom, backache, is nonspecific. Considerable delay in diagnosis may occur before an infectious process is considered. Even when a diagnosis of spinal tuberculosis is considered, it may be difficult to confirm. Radiological findings indicative of tuberculosis are involvement of the vertebral bodies on either side of the disc, subligamentous spread, abscess formation and collection and expansion of granulation tissue adjacent to the vertebral body, relative sparing of the disc space and calcification within a paravertebral abscess. We report two patients with spinal tuberculosis who had nonspecific backache and received a delayed diagnosis for several months or yearsope

The current status of anesthesiology clerkship in Korea

Background: There had been few regulations or agreements between medical schools how to teach undergraduate medical students during anesthesiology clerkship. We conducted this survey to figure out the current status of the clerkships of medical schools in Korea, and suggest the direction of development. Methods: The questionnaires about anesthesiology clerkship were sent to chairpersons or clerkship directors of 42 medical schools in Korea by electric mail. The answers were collected by internet system. Results: 33 schools answered the questionnaires. The clerkships were elective in 19 schools, but 26 schools answered that the anesthesiology clerkship should be included in core clerkships. Only a few schools oriented the students about ethical issues and occupational health during clerkship. Most schools evaluated the students by evaluation sheet or written examination. Oral or skill tests were used at only 8 and 5 schools, respectively. Conclusions: The answers of survey showed that there were many aspects to be improved in anesthesiology clerkship although the responses of students toward the clerkship were positiveope

A Study on Service Marketing Strategy for TSR Service Operators in Korea

Nowadays, Trading volume in North East Asia area has grown up rapidly, additionally North trading especially Russia & Central Asia has been considerably increased. Even though TSR service is the leader for North Trading has considerable competitiveness for the connection between Far East Asia and Eurpoe, It is faced with difficulties due to change of Russia surrendings & development of competitor route(TCR, Deep-sea route). We need exact strategy and execution of service marketing for TSR service operator in Korea in order to maximize TSR advantage and keep the leader of North trading. This Research is supplying for basic grounding of active service marketing strategy foundation in the severe competitive market environment and suggesting needed theory and direction for effective marketing strategy of TSR service operator in Korea. This research's summary is as follows. First part is SWOT analysis of TSR service operator in Korea. This research analyzed difference of recognition between TSR service operator group who is service provider and their clients group who is cargo owner. There is a difference of recognition in almost parts of SWOT analysis. It is needed exact environment analysis of TSR service operator continuously. Second part is empirical analysis of service marketing strategy for the TSR service operators in Korea. This research analyzed difference of recognition between TSR service operator group and their clients group. There is a difference of recognition in almost parts of service marketing strategy. Under this results, TSR service operator in Korea is needed to found service marketing strategy and to excute. Considering above two things, TSR service operators‘ service marketing strategy is not quite satisfied yet. It is analyzed that TSR service operators should aggressively utilize effective service marketing strategy for the good results of management.제1장 서 론 1 제1절 연구배경과 목적 1 제2절 연구방법 및 구성 3 제2장 TSR Service Operator의 서비스 마케팅에 관한 이론적 배경 5 제1절 TSR Service Operator의 개념 5 1. TSR의 개념 5 2. TSR Operator의 개념 8 3. TSR Operator의 특징 및 역할 10 제2절 TSR서비스 Operator의 마케팅 14 1. 서비스 마케팅의 일반적 고찰 14 2. TSR Service Operator의 서비스 마케팅 24 제3장 우리나라 TSR Service Operator의 SWOT 분석 32 제1절 TSR서비스 물동량 처리현황 32 1. TSR서비스 화물 처리실적 32 2. 우리나라 TSR서비스 컨테이너화물 처리실적 34 제2절 우리나라 TSR Service Operator의 SWOT 분석 42 1. 강점 44 2. 약점 52 3. 기회 61 4. 위협 66 제3절 우리나라 TSR Service Operator의 보완사항에 대한 중요도 우선순위 분석 71 1 전체집단 우선순위 검정 71 2. 집단별 우선순위 검정 72 제4장 우리나라 TSR Service Operator의 서비스마케팅전략 74 제1절 TSR Service Operator의 서비스마케팅 전략수립 74 제2절 제품전략 77 1. 우리나라 TSR Service Operator의 제품전략에 대한 분석 78 2. 우리나라 TSR Service Operator의 제품전략 80 제3절 가격전략 84 1. 우리나라 TSR Service Operator의 가격전략에 대한 분석 84 2. 우리나라 TSR Servie Operator의 가격전략 86 제4절 유통전략 88 1. 우리나라 TSR Service Operator의 유통전략에 대한 분석 88 2. 우리나라 TSR Service Operator의 유통전략 90 제5절 촉진전략 91 1. 우리나라 TSR Service Operator의 촉진전략에 대한 분석 92 2. 우리나라 TSR Service Operator의 촉진전략 94 제5장 결론 98 제1절 연구결과의 요약 98 제2절 연구의 시사점 101 제3절 연구의 한계점과 향후 연구과제 102 참고 문헌 104 국내 문헌 104 외국 문헌 106 [부 록] 설문지 10

반폐쇄식 순환형 호흡회로를 이용한 흡입마취시 활성탄소 여과기가 마취로부터의 회복에 미치는 영향

Dept. of Medicine/석사[한글] 활성탄소는 다양한 종류의 물질들을 흡착할 수 있는 특성이 있어 예전부터 약물이나 독성 물질 중독 시에 경구적으로 투여함으로써 위장관에서의 흡수를 막아주고 체내로부터의 제거를 촉진시켜 전신 독성의 예방이나 치료에 사용되어 왔다. 마취에 있어서도 활성탄소는 흡입마취제를 효과적으로 흡착시킨다는 연구 결과가 보고되어 있다. 그러나, sevoflurane과 desflurane은 낮은 혈액/가스분배계수를 가지고 있어 현재 널리 쓰이고 있는 흡입마취제이지만, 이에 대한 활성탄소의 흡착효과에 대한 연구결과는 아직 보고된 바가 없다.본 연구에서는 기도삽관 하에 흡입마취제 (sevoflurane, desflurane)를 이용하여 전신마취를 시행한 성인 남녀 60 명을 대상으로, 마취기계의 호기 회로에 활성탄소 여과기를 부착하는 것이 이 두 흡입마취제를 이용한 마취로부터의 회복 시 각성 속도에 어떤 영향을 미치는지에 대하여 각각 알아보고자 하였다. 또한 BIS를 이용하여 마취 중과 회복 시에 마취심도의 평가를 객관적으로 하고자 하였다. 활성탄소 여과기를 사용한 군을 실험군으로 하고 사용하지 않은 군을 대조군으로 하였으며, 회복기간에는 환자의 생체 징후와 BIS의 변화, 그리고 호기 및 흡기 내의 마취가스 농도의 변화를 기록하였고, 궁극적으로 환자의 각성까지 걸리는 시간과 발관 시간, 술 후 각성 상태 등을 평가 비교하였다.흡입마취제의 투여를 중단한 후 sevoflurane 실험군이 sevoflurane 대조군보다 구두 명령에 반응하여 눈을 뜨는 시간이 유의하게 빨랐으며 (11.1±3.8 vs. 14.8±3.0 min), 발관시간도 실험군에서 유의하게 빨랐다 (11.9±3.9 vs. 15.3±3.2 min). 이는 desflurane에서도 마찬가지로, 실험군에서 눈을 뜨기까지 걸린 시간 (6.2±1.4 vs. 10.3±1.7 min)과 발관까지 걸린 시간 (6.7±1.4 vs. 10.5±1.1 min)이 대조군에서보다 모두 유의하게 짧았다. 각 흡입마취제에서 대조군과 실험군 사이에 각성 시 BIS의 차이는 없었다. 회복시 폐포내 흡입마취제 농도의 시간상수(τ)는 sevoflurane 실험군의 시간상수 (1.7±0.5 min)가 sevoflurane 대조군의 시간상수 (2.5±1.1 min)보다 유의하게 짧았으며, desflurane 실험군의 시간상수 (1.4±0.3 min) 또한 desflurane 대조군의 시간상수 (2.0±0.3 min)보다 유의하게 짧았다.Sevoflurane과 desflurane에 대한 본 연구에서, 활성탄소 여과기의 사용이 흡입마취제를 호흡회로에서 효과적으로 제거할 수 있게 하고 환자의 각성시간을 유의하게 단축시킨다는 결론을 얻었다. [영문] Activated charcoal has the ability to adsorb a wide variety of substances. This property can be used to prevent the gastrointestinal absorption of various drugs and toxins and to facilitate their elimination, even after systemic absorption. In many previous studies, charcoal has also been shown to adsorb halothane or isoflurane efficiently and thus hasten anesthetic recovery. Recently, sevoflurane and desflurane have been used more frequently because they have a lower solubility than do halothane or isoflurane. In the present study, we evaluated the efficiency of charcoal filters in eliminating sevoflurane and desflurane during recovery from inhalation anesthesia in a semiclosed circuit. Bispectral index (BIS) values were monitored to evaluate the patients’ hypnotic states over the duration of this study.After obtaining informed consent, sixty healthy patients were randomly assigned to one of four groups: the sevoflurane control (without charcoal filter) group, the sevoflurane with charcoal filter group, the desflurane control group, or the desflurane with charcoal filter group. Anesthesia was induced with 2 µg/kg of fentanyl, 5 mg/kg of thiopental sodium, and 0.6 mg/kg of rocuronium. During maintenance of anesthesia, ventilation was controlled to maintain normocapnia, and BIS values were adjusted between 40 and 50. At the end of surgery, a charcoal filter was attached to the expiratory limb of the breathing circuit of charcoal filter group subjects. After inhaled anesthetics were discontinued, ventilation was controlled with the same minute volume as the intra-operative period and at a fresh gas flow rate of 5 L/min with 100% O2. From this time, BIS, inspiratory, and end-tidal anesthetic concentrations were recorded every 30 seconds. The times from discontinuing the anesthetic to obeying commands, such as eye opening, and to extubation were recorded.For the sevoflurane group, use of a charcoal filter resulted in more rapid eye opening (11.1±3.8 vs. 14.8±3.0 min) and shorter extubation time (11.9±3.9 vs. 15.3±3.2 min) compared with those of the control group. For the desflurane group, eye opening (6.2±1.4 vs. 10.3±1.7 min) and extubation (6.7±1.4 vs. 10.5±1.1 min) also occurred more rapidly in the charcoal filter group than in the control group. There were no differences in BIS values at the time of eye opening between the control and charcoal filter groups for both inhaled anesthetics. The exponential time constant (τ) of alveolar anesthetic concentration in the charcoal filter group was significantly shorter than that in the control group for both sevoflurane (1.7±0.5 vs. 2.5±1.1 min) and desflurane (1.4±0.3 vs. 2.0±0.3 min).A charcoal filter attached to the expiratory limb of the semiclosed rebreathing circuit during recovery from inhalation anesthesia (sevoflurane or desflurane) adsorbed exhaled anesthetics and reduced the reuptake of these substances, which resulted ultimately in a shortened emergence time.ope

MgCNi3, MgB2, La1.87Y0.13CuO4 초전도체들에서 보이는 자기 소용돌이 동역학 연구

DoctorThe vortex dynamics of superconducting materials MgCNi3, MgB2 and La1.87Y0.13CuO4 was studied. The La1.87Y0.13CuO4 (LYCO) superconductor was expectedto show an antiferromagnetic insulating behavior at a first glance but superconductivity of Tc = 17 K has been reported when Y3+ was in the La site. In spite of the urgent need to identify the origin of the superconductivity,this compound was not studied in detail because of the limited sample availability. One of the first questions to be answered was about the superconducting dimensionality. Analysis of I-V characteristics of LYCO thin film showed three-dimensional (3D) superconducting scaling behavior, although this material has a quasi-2D crystal structure. This scaling behavior of this material was very similar to other 3D superconductors, such as Mo3Si, MgB2,and YBa2Cu3O7, but not that of 2D Bi2Sr2Ca2Cu3Ox. From these results, 3D scaling behavior was confirmed.While the scaling behavior of the vortex matter is readily predictable from the theory based on elastic manifolds in vortex lattice in a random pinning circumstance, the peak effect (PE: sudden increase of critical current nearthe end of the superconductivity) has been a puzzling problem in vortex physics. Recently I have successfully grown MgCNi3 single crystals which aresuitable for study of the PE. With this new superconductor, the PE by using DC and AC excitation currents in a strip geometry is investigated. Remarkably, critical current (Ic) measured by using DC showed very sharp transition incontrast to previously reported results based on edge contamination scheme in anisotropic vortex system in NbSe2. Furthermore, Ic determined from ACresponse of the system exhibits collapsing peak as the frequency of driving current increases. Current-voltage characteristics at different frequencies and transient behavior of vortex matter supports existence of AC induced flux creep. I attribute the AC induced creep to isotropic nature of vortices in MgCNi3 single crystals. Since it becomes clear that the PE originates from dynamical reason, transient behavior of vortex matter in the vicinity of the PE has to be understood. In principle, to see the real space flow pattern of vortex matter is the ultimate task. However, any experimental tool now at hand to visualizemoving vortices is not available. So, noise investigation from transport measurement is still one of the best ways to deduce vortex follow pattern. In this thesis, new result from MgCNi3 showing that chaotic intermittency of vortex flow is presented together with random telegram type noise. Then, the result will be related to chaotic theory. In the last chapter of the thesis, I present temperature dependent surface superconductivity of MgB2. The temperature dependence of the ratio Hc3/Hc2 at different angles was qualitatively well described by a recent theory based onthe two-gap nature. The angular dependence of this ratio shows that it can be both enhanced and reduced, which can be explained by the two-band theory. Theslight deviations of Hc3/Hc2 from the theory of the half-infinite geometry are to be accommodated by effects due to the finite geometry and to the orientation of the applied field relative to the crystal plane

팔라듐 촉매 하 아미도알렌 의 위치- 및 거울상 선택적 수산화작용기화

Master아미도알렌은 독특한 구조와 반응성을 가지는 흥미로운 화학종이다. 아미도 알렌은 질소 작용기를 도입하기 위한 빌딩 블록으로 금속 촉매 하에서 다양한 반응에 활용되었으나 개념상 가장 효율적인 수산화 작용기화에 대한 연구가 충분히 이뤄지지 않았다. 이에 더해, 아미도알렌의 수산화작용기화에서 위치- 및 입체선택성을 제어하는 것은 훨씬 더 도전적인 과제로 알려져있다. 생물할적 활성을 갖는 다양하고 복잡한 질소 함유 분자에 대한 관심이 증가하는 가운데 간단하고 효율적인 합성 방법은 꾸준히 요구되고 있다. 이에 따라 본 학위 논문에서는 다양한 친핵체들을 아미도알렌에 위치- 및 거울상 선택적으로 첨가하는 팔라듐 촉매 반응에 대한 연구를 다룬다. 먼저, 우리 그룹에서 개발한 팔라듐 촉매 하 헤테로 친핵체의 알콕시알렌으로 첨가 반응이 아미도알렌에서도 수용될 수 있다는 것을 증명했다. 산소 친핵체로 사용된 알코올은 높은 가지-선택성과 입체 선택성을 지녔으며, 질소 친핵체가 촉매 반응 내에서 가역적 거동을 통해 라세미화 되는 사실을 밝혔다. 또, 팔라듐 촉매 하 탄소 친핵체의 위치- 및 거울상 선택적 반응에 대한 연구를 보고하였다. 연성 탄소 친핵체의 가역적 거동을 다시 한 번 발견했고 이에 대한 대안으로 비가역적 탈탄산화 첨가 반응을 제시했다. 팔라듐 촉매 하 아미도알렌에 베타-케토산의 탈탄산화 첨가 반응이 개발되어 리간드-주도로 감마, 델타-비포화 베타-아미도 케톤의 위치- 및 거울상 선택적 합성이 가능하다는 것을 입증했다. 이번에 보고한 팔라듐 촉매 반응은 아미도알렌이 더 넓은 범위의 합성적 변환에 활용될 수 있는 가능성을 제시한다.Amidoallene is an interesting chemical species with a unique structure and reactivity. As a building block for introducing a nitrogen functional group, amido allene has been used for various reactions under transition metal-catalyst, however, conceptually, the most efficient hydrofunctionalization has not been sufficiently studied. In addition, controlling the regio- and stereoselectivity in the hydrofunctionalization of amidoallene is known to be an even more challenging subject. With the increasing importance of diverse and complex nitrogen-containing bioactive molecules, more efficient synthetic methods are constantly in demand. Accordingly, this thesis deals with the study of the palladium-catalyzed addition of various nucleophiles to amidoalene in regio- and enantioselective manner. First, we demonstrated that palladium-catalyzed addition of heteroatom nucleophiles to alkoxyalene developed by our group can also be accommodated in amidoallene. A s an oxygen nucleophile , allyl alcohol showed high branchselectivity and stereoselectivity, and it was revealed that nitrogen nucleophile was racemized through reversible behavior in the catalytic reaction. In addition, studies on the palladium-catalyzed regio- and enantioselective addition of carbon nucleophiles were reported. We once again discovered the reversible behavior of soft carbon nucleophiles, and proposed an irreversible decarboxylative addition as an alternative. A palladium-catalyzed decarboxylation addition of β-keto acids to amidoallene was developed, demonstrating that ligand-driven regio- and enantioselective synthesis of γ , δ-unsaturated β-amido ketones is possible. This palladium-catalyzed reaction opened up the possibility that amidoallene could be used in a wider range of synthetic transformations

Effect-site concentration of remifentanil for laryngeal mask airway insertion during target-controlled infusion of propofol

The purpose of this study was to determine the effect-site concentration of remifentanil that would provide optimal conditions for successful laryngeal mask airway insertion during a target-controlled infusion (TCI) of propofol at 3.5 microg.ml(-1) without the use of neuromuscular blockade. Five minutes after propofol infusion, remifentanil was infused at a dose determined by a modified Dixon's up-and-down method. Five minutes after remifentanil infusion, the laryngeal mask was inserted. The effect-site concentration of remifentanil for successful laryngeal mask insertion in 50% of adults (EC(50)) was 3.04 (SD 0.49) ng.ml(-1) during a TCI of 3.5 microg.ml(-1) propofol without neuromuscular blockade. From the probit analysis, the EC(50) and EC(95) of remifentanil were 2.84 ng.ml(-1) (95% CI 2.09-3.57 ng.ml(-1)) and 3.79 ng.ml(-1) (95% CI 3.26-9.25 ng.ml(-1)), respectively.ope

Postoperative intravenous patient-controlled analgesia in thyroid surgery: comparison of fentanyl and ondansetron regimens with and without the nonsteriodal anti-inflammatory drug ketorolac

BACKGROUND: Nonsteroidal anti-inflammatory drugs (NSAIDs), through synergistic action with opioids, can reduce postoperative nausea and vomiting via intravenous patient-controlled analgesia (PCA). We compared the efficacy of three PCA regimens. METHODS: Patients (n = 135) undergoing thyroidectomy were randomly allocated to three PCA regimens. All groups received 12 mg ondansetron (a serotonin 5-HT(3) receptor antagonist). In addition, Group I received the opioid fentanyl, 15 microg/kg. Group II received fentanyl 12.5 microg/kg and the NSAID ketorolac, 1.5 mg/kg, and Group III received fentanyl 10 microg/kg and ketorolac 3 mg/kg. Pain scores, nausea and vomiting, and dizziness were assessed 1, 6, 12, and 24 hours postoperatively. RESULTS: Pain scores were similar among the three groups. However, postoperative nausea and vomiting was significantly lower in groups II and III (p < 0.05) than group I. Postoperative dizziness was significantly lower in group III than groups I and II (p < 0.05). CONCLUSIONS: The NSAID ketorolac when combined with lower doses of the opioid fentanyl and the same dose of ondansetron is associated with the same analgesic efficacy but less nausea and vomiting after thyroid surgery. A higher ratio of NSAID to opioid, when used as reported here, is associated with less postoperative dizziness.ope